Provider First Line Business Practice Location Address:
1614 S MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75633-9411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-693-4511
Provider Business Practice Location Address Fax Number:
903-693-4643
Provider Enumeration Date:
08/31/2006